- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.62 / $1,868.62 / $9,119.00
| Facility | | $1,868.62 | $1,868.62 | $9,119.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,024.85 / $9,024.60 / $15,635.81
| Facility | | $5,024.85 | $9,024.60 | $15,635.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,287.43 / $6,083.26 / $14,634.10
| Facility | | $4,287.43 | $6,083.26 | $14,634.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,487.18 / $5,561.56 / $11,522.91
| Facility | | $3,487.18 | $5,561.56 | $11,522.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.03 / $3,252.78 / $9,092.45
| Facility | | $1,898.03 | $3,252.78 | $9,092.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $9,404.00 / $12,475.70
| Facility | | $3,991.00 | $9,404.00 | $12,475.70 |